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Our problem is your problem - social care and the NHS

Paul Carey-Kent, health and integration policy manager at CIPFA, the Chartered Institute of Public Finance and Accountancy, reflects on the increasing melt-down in the social care sector and what it means for the NHS.

Since 2010, local government has had to grapple with significant funding reductions. As social care is the largest area of spending controlled at a local level, it is no surprise it has been severely affected. And despite both councils and the government introducing measures to support the sector, it is becoming increasingly clear that a melt-down is likely.

A recently published survey from the Association of Directors of Adult Social Services (ADASS) highlights just how tough things were in local government last year. There was a national net social care overspend of £168m, the first such recorded, and, also for the first time, a majority of the 152 councils involved overspent their adult social care budget.

The introduction of the National Living Wage has added to this pressure and is estimated to have increased council spending on social care by 1.2% this year (and will add £600m to costs in 2016/17). This, combined with an annual 3% increase in population of older people, has led to a 3% real terms cut.  Councils have dealt with such challenges before, but it gets harder each year as many of the simpler cost reduction measures have already been taken.  

The ADASS survey also tracks the confidence financial directors in councils have in their ability to make savings in social care. The results reflect the tough financial position they are facing – only 31% believe they can meet the savings targets compared to 45% last year. Worryingly, only just over a third (36%) are confident they are meeting their statutory duties.  These statistics are not likely to improve considering the ability of authorities to spend now on preventative action is squeezed, ramping up the longer term problem.

The pressures the sector are under also represent a significant threat to the just-as-cash-strapped NHS. Health and social care are intertwined, as the government’s encouragement of their integration recognises, and a good proportion of the impact of problems in social care services will fall on health. So, if social care looks close to breaking point, what will this mean for the NHS?

Approximately 40% of hospital ‘bed blockers’ are now staying longer than they need to because their social care needs aren’t being met. This is compared to 25% in 2010. This can mean using a bed costing the NHS £2,000-£3,000 a week for the want of social care more likely to cost £500 per week. Delayed transfers for older people alone costs £820m a year, according to the National Audit Office.

With the NHS under pressure to save £22bn by 2020, it is unclear how things will improve. Health and social care need to be working together to reform the whole system, yet their budgetary positions appear designed to encourage them to retreat into desperate measures to protect their own bottom lines. This is at the expense of the collaborative investment and transformation that is desperately needed for the longer term. 

Can the new prime minister solve the problem? CIPFA has proposed in its More Medicine Needed report that the whole health and social care system needs to be funded on a more secure and less politically exposed basis. Theresa May should call for a Commission to assess the appropriate proportion of GDP to be spent on health and social care and to recommend the measures likely to be needed to make that a reality. Only radical fiscal action will save the sector from melt-down and so far this sort of approach is not looking likely. 

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